Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | M5080 | TX |
N | 207KA0200X | Allergist | M5080 | TX |
N | 207R00000X | Internist | M5080 | TX |
N | 111NI0900X | Internist | M5080 | TX |
Y | 207RA0201X | Internist - Allergy & Immunology | M5080 | TX |
N | 207RR0500X | Rheumatology | M5080 | TX |
NPI | 1487844775 |
---|---|
Provider Name | Kristin L Bussey-Smith |
First Address | San Antonio, TX 78258-3365 |
Second Address | San Antonio, TX 78258-3365 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 04/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
191307101 | (05) | TX |